World Health Assembly Kicks Off WHO Reform Process, Moves Forward on IP-related Issues

25 May 2011

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The World Health Organisation's annual assembly kicked off last week with discussions on the organization's work over the past year, the challenges it faces in a changing global economy, and a spirited debate on the future shape and finances of the institution itself.The meeting also addressed issues such as pandemic influenza preparedness, vaccines, fake medicines, communicable and non-communicable diseases and HIV/AIDS, among others.

The purpose of the World Health Assembly, the WHO's top decision-making body, is to supervise financial policies, review programmatic goals, and determine organizational practices. Christos Patsalides, Cypriot health minister, was elected president of this assembly.

A day-by-day summary of the proceedings of the 64th World Health Assembly can be found here.

DG initiates reform discussions

In her opening address, WHO Director-General Margaret Chan highlighted the organisation's accomplishments of the past five years, but also recalled the challenges posed by the financial crisis together with skyrocketing food and fuel prices. She urged member states to "remember the people" because "all of our debates and discussion have meaning only when we improve the health of people and relieve their suffering."

Chan also opened talks on a proposal for WHO reform, which she described as the "largest in its 63 year history." The proposed reforms, she suggested, would provide the organization the opportunity to be more effective, responsive, transparent and accountable in its activities. Member states showed strong support for the proposal, paying special notice to the issue of financing reform for WHO.

One of the major changes would be an independent evaluation of the WHO's work, which would then be used to gauge where the institution stands. More immediately, the organisation will undergo drastic budget cuts, including the need to let go 300 staff members. The assembly approved a revised WHO program budget of US$3.959 billion for 2012-2013, as compared to US$4.54 billion in 2010-11. In addition to declining contributions by governments, the WHO will continue to receive funding from other UN agencies, foundations and the private sector.

The WHO has secured some funding from the Bill & Melinda Gates Foundation for the implementation of the reform plan, though the exact amount remains unclear. On Tuesday, Bill Gates addressed the assembly and emphasised his commitment to eradicate polio, while thanking member states for their continued leadership in fighting disease.

NGOs concerned about private sector influence

Some groups feel that the proposal for reforming WHO financing could result in conflicts of interest among the organisation and its private funders.

In a joint statement, a handful of NGOs argued that the reform package "does not adequately address the management of conflicts of interest, and presents an unrealistic and empirically unsupported assumption that all stakeholders will collaborate to advance the public interest." They also found it "entirely inappropriate that the blueprint for reform of a UN institution is funded by a private entity." In their view, "a clear separation between WHO and the interests of private actors must be maintained".

Also figuring in the reform proposal was a multi-stakeholder platform called the World Health Forum which would allow WHO observers from civil society groups, the private sector and academia to be a part of decision-making at WHO. Some member states and civil society groups were wary of this measure, again fearing "it may push the agency too far into the hands of its financial supporters."

Intellectual property features prominently

Intellectual property-related matters figured prominently during discussions at the World Health Assembly. Governments considered the issue of "bad medicines," with members discussing a report on improving access to quality and affordable medical products. The report was prepared by the WHO's working group on substandard/spurious/falsely-labelled/falsified/counterfeit medical products.

Though all member states seemed to agree that "bad medicines" are a serious public health issue, some argued that the WHO has delved too deeply into intellectual property concerns instead of focusing on public health. Ultimately, member states agreed to give the working group more time to complete its work before taking any action.

In a public health milestone, the assembly's Committee A, which is charged with technical and health matters, agreed on a framework for pandemic influenza preparedness that includes provisions for benefit sharing and would ensure access to vaccines for developing countries. The "landmark agreement" had been long in the making after recent years had shown a rise in influenza viruses of pandemic potential, such as the H1N1 (swine flu) or H5N1 (avian flu) viruses.

Though the framework had been nearly finalized earlier in the year, some amendments were made to it this time around, including the deletion of a clause mentioning the Nagoya Protocol on Access to Genetic Resources and the Fair and Equitable Sharing of Benefits Arising from their Utilization to the Convention on Biological Diversity. Other amendments to the framework were additions, such as the reference to Article 23 of the WHO Constitution, which states "The Health Assembly shall have authority to make recommendations to members with respect to any matter within the competence of the Organization." Another addition is the mention of a biannual reporting system for the work completed under the framework.

The framework agreement, as well as other resolutions approved in the committees, was formally adopted at the final plenary of the WHA on 24 May.

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